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August 6, 2018

CMS Rules Have Medicare Payment Increases for Acute, Post-Acute Facilities, Finalizes Inpatient Rule
A number of finalized payment rules were posted by CMS with very few changes to the original proposals that impact both acute and post-acute care facilities:
  • The final hospital inpatient rule will boost payments to acute care hospitals by $4.8 billion in FY 2019 and, in a move CMS says is important to transparency, will require hospitals to post their standard charges on the internet. Within the same rule, CMS will increase payments to LTCHs by $39 million in FY 2019 and once and for all get rid of the 25-percent rule. Click here for the CMS fact sheet, and here for the rule.
  • The inpatient rehabilitation facilities final rule gives a $103 million increase in payments in FY 2019 and removed a number of data collection requirements to reduce paperwork for IRFs, one that was met with opposition – the removal of the Functional Independence Measure (FIM) Instrument and associated Functional Modifiers from the IRF patient assessment. Click here for the fact sheet, and here for the rule.
  • Skilled Nursing Facilities received a $820 million bump in payment for FY 2019 however, in a controversial move, CMS is going forward with what is being called a complete redesign of the SNF payment system. In particular, they are shifting the focus more on clinically relevant factors and less on the volume of therapy provided beginning in FY 2020. Click here for the fact sheet, and here for the rule.
  • The final rule for the Inpatient Psychiatric Facilities increases payments by $50 million and removes five quality measures from the FY 2020 payment determination – influenza vaccination coverage among health care personnel; alcohol use screening; tobacco use screening; use of an electronic health record; and assessment of patient experience of care. Click here for the fact sheet, and here for the rule.
  • Hospices will receive $340 million more in payment in FY 2019 and CMS finalized a policy to recognize physician assistants as attending physicians for Medicare hospice patients, as required by the Bipartisan Budget Act of 2018. The rule also finalizes changes to the Hospice Quality Reporting Program (Hospice QRP) including several procedural policies such as a review and correction timeframes as well as several public reporting policies and procedures. Click here for the fact sheet, and here for the rule.
House Committee Want Answers from 340B Contract Pharmacies
Leadership of the House Energy and Commerce Committee sent letters to nine contract pharmacies including major chain drug stores CVS, Walgreens, and Walmart probing into their participation in the 340B drug discount program. This follows a series of hearings into the program, as well as reports by both the Committee staff and the GAO that highlighted weaknesses in the contract pharmacy program. Lawmakers are seeking details on how much money pharmacies recoup from each 340B prescription, whether the agreements with 340B hospitals require the companies to offer discounts to uninsured and low-income patients on 340B drugs, and how the pharmacies prevent diversion of 340B medicine. To view the letters, click here.
Healthgrades Announces Women’s Care Awards for Hospitals
Healthgrades has announced the recipients of its 2018 Women’s Care Awards. The Gynecologic Surgery Excellence Award, Labor and Delivery Excellence Award and the 2018 Obstetrics and Gynecology Excellence Award recognize U.S. hospitals showing superior outcomes in women’s care services. Healthgrades looked at patient outcome data for all patients made available in 15 states and the District of Columbia from 2014 through 2016. State data availability is subject to annual changes because of data release time frames as well as new regulations and laws.  Click here for lists of all awardees.  Click here for the detailed press announcement.
Four Major US Cities Sue Administration Over Health Law Changes; Short Term Plans Coming
Four cities – Baltimore, Maryland; Columbus, Ohio; Cincinnati, Ohio; and Chicago, Illinois – last week filed a suit against the Trump Administration over its efforts to allegedly undermine the Affordable Care Act. City officials argue that HHS attempted to discourage enrollment, increase prices and spread uncertainty in insurance markets. Additionally, the suit alleges that administration officials have misappropriated funds that were intended to support the ACA and instead used the money to challenge it, through such actions as shortening the sign-up period and decreasing outreach funding. To view the suit, click here.
  • Kaiser Family Foundation report finds that individual market enrollment has declined by 20-percent since 2015 mostly due to people not qualifying for ACA subsidies, click here.
  • The Administration announced its final rules for short term health plans.  Click here for a summary.
  • The Administration’s new short-term health plans may not get an easy launch in many states.  Pennsylvania’s insurance commission has put HHS on notice of its intent to provide rigorous oversight. Click here.
  • The NY Times reports that President Trump turned down an effort by top HHS officials to allow for more modest expansions of state Medicaid programs, after a vigorous internal debate.  Click here.
Joint Commission Adds Newborn Measure to Accreditation Requirements
In a release on July 31st, the Joint Commission announced that beginning on Jan. 1, 2019, a new accreditation measure will require hospitals to identify the percentage of infants with unexpected newborn complications among full-term newborns who do not have pre-existing conditions. Joint Commission-accredited hospitals that have at least 300 live births annually will have to add a new requirement, called PC-06 Unexpected Complications in Term Newborns, to the organization’s five required measures. Any hospital that seeks perinatal care certification from the Joint Commission will also have to report PC-06. Click here for more.
HHS’ Drug Importation Proposal Gets a Closer Look
Previously opposed to the idea of drug re-importation, HHS Secretary Alex Azar and FDA Commissioner Scott Gottlieb are considering all options as drug prices in the US continue to rise. HHS recently assembled a working group aimed at determining how drug importation would assist in regulating dramatic price increases in certain drugs. Critics of the working group say it is too narrow of a solution to the dynamic problem of drug pricing as well as importation’s ability to only affect the generic market and not the high price brand name drug market. Drug re-importation is one of multiple proposed solutions that HHS has suggested in order to combat high drug prices, a problem of chief concern for the administration and the American public. To read the Kaiser Health News report, click here.
FCC Seeks Comments on Proposed $100 Million Telehealth Pilot
The Federal Communications Commission has put out a notice requesting stakeholders to weigh in on a its  “Connected Care Pilot Program” to support the delivery of advanced telehealth services. The Notice of Inquiry (NOI) released on Aug. 2nd, looks for comments and advice on the creation of a Universal Service Fund pilot program to promote the use of broadband-enabled telehealth services among low-income families and veterans in America. The NOI was posted shortly after the FCC approved the new $100 million. To read the notice and the requirements, click here.
Hospital Bacteria Becoming “More Tolerant” to Hand-Sanitizer
Several strains of harmful bacteria are becoming more resistant to alcohol-based hand-sanitizers, a new study published in the journal of Science Translational Medicine shows. Alcohol-based disinfectants are commonly utilized to control hospital infections, but for a type of bacteria called enterococci, which is a leading cause of the blood condition sepsis in North America and Europe, hand-sanitizer is an increasingly unreliable preventative measure. Researchers compared 139 types of bacteria over a 19-year stretch, from 1997 to 2015. Bacteria collected after 2009 were 10 times more tolerant than pre-2004 bacteria to alcohol mixtures— which corresponds to the national push to use more hand-sanitizers. Click here to read the study.

Capital Funding for Rural Healthcare Guide Showcases Funding Opportunities
The Rural health Information Hub updated its ‘Capital Funding for Rural Healthcare’ guide, which serves as a resource of funding opportunities for rural health organizations. The list includes information on grants and loan programs, eligibility requirements, and fundraising opportunities. The guide aims to show rural health executives where they can find the capital support they need in order to continue providing excellent care to their community. Click here for the guide.
Study Shows Link Between Dehydration and Mental Performance
In new research recently released by NIH, mild dehydration could affect mental performance. The research looked at 33 operate studies on dehydration and found a link between mild dehydration and the ability to perform complex tasks. Overall there is about a 12% increase in errors by those that were dehydrated versus when they were sufficiently hydrated. The study points to possible areas where 12% mistakes could matter like a student or more gravely like a pilot or a solider, and notes that it is best to stay hydrated no matter what you’re doing. Click here for the study.
Study Finds Cat Bacteria Increases Entrepreneurship
A study from The Royal Society has linked the parasite Toxoplasma Gondii, commonly found in cat poop, to an increase in entrepreneurship for those infected. While seeming outlandish, the parasite has been linked before to an increase in testosterone, the male sex hormone, which also leads to aggressive and risk taking behavior. This is where the entrepreneurship comes in. Because risk is often involved in starting a businesses those less adverse to the idea of risk would seem to be more likely to engage in them. The study concluded this from looking at business and non-business majors over a five year period. They found that business majors were 1.4 times more likely to be infected with the parasite than non business majors and that those that started their own business of company were 1.8 times more likely to be infected. To read the full study, click here.
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